Basal cell carcinoma within vulvar Paget's disease

An 85-year-old Japanese woman had noticed erythema on her vulvar region 3 y ears before. The erythema gradually increased in size and followed erosion and ulceration with pigmentation on the edge of the erythema. A skin biopsy from the pigmented area showed large round cells with ample cytoplasm, whi ch formed nests or glandular structures. In the dermis there was mass forma tion of basophilic cells and peripheral cells in a palisade arrangement. Th e tumor cells in the epidermis showed positive immunoreactivity for carcino embryonic antigen; on the other hand, the dermal tumor was negative. We dia gnosed that the tumor in the epidermis was vulvar Paget's disease, and the dermal tumor was a solid type of basal cell carcinoma. We speculate that th e vulvar Paget's disease preceded and then the basal cell carcinoma develop ed in the area of Paget's disease. This is the first report in which basal cell carcinoma in the area of Pager's disease was documented.